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The clinical anesthesiologist should appreciate that mental illnesses, cognitive disorders, and mental health problems affect all walks of life. It is a fact that few families in America are untouched by mental illness. An estimated 26.2 % of Americans aged 18 and older suffer from a diagnosable mental disorder in a given year. Mental disease interferes with life activity and ability to function and constitutes a pervasive and prevalent health problem among varied American population subsets, including the young and the elderly. The presence of mental disorders, associated symptoms, possible concomitant pathology, and prescribed medications is of significance to all health-care providers and not simply those in the field of mental health.

Induction agents have a variety of roles in the practice of anesthesiology. Most commonly, they are used to promote induction of general anesthesia or to provide sedation in the intensive care setting or for monitored anesthesia care. In recent years, propofol, etomidate, and ketamine have evolved as the principal induction agent in clinical practice.

This chapter provides a systemic review of trauma-related physiological changes with tremendous updated information. The first part of this chapter analyzed the general physiological changes according to the following categories: (1) hemorrhage-related changes: trauma-related vicious cycle of hemorrhage, resuscitation, and coagulopathy; mechanisms of acute trauma coagulopathy (excessive activation of coagulation, hyperfibrinolysis, hypothermia, acidosis, increased capillary permeability, and platelet dysfunction). (2) Stress-related changes (behavioral activation). (3) Pain-related changes (ventilation and mental status). (4) Inflammatory changes and sepsis. (5) Metabolic changes. The second part of the chapter discussed three system-specific physiological changes after trauma: head trauma, chest and cardiac trauma, and trauma to abdominal and digestive system.

Pediatric trauma is a significant issue for our country. Anesthesiologists are commonly involved with their care as they move through different hospital venues. Because of this, anesthesiologists should have knowledge and awareness of subtleties and standards involved with their treatment.

The eloquent area of the brain is responsible for written and verbal communication. Functional neuroimaging indicates that interindividual variation exists with the anatomical location of the eloquent area of the brain. Some patients have shown significant contribution from areas located near, but outside of, the traditionally recognized eloquent area. Classically, these areas adjacent to or near the eloquent area were thought to have little impact on written or oral language skills, and many neurosurgeons, in the past, underestimated the impact of operating in these areas. Now, each patient is known to have a unique eloquent area. This necessitates intraoperative cortical mapping to more accurately identify functioning before removing brain tissues in patients undergoing epilepsy or brain tumor surgery in areas near this region of the brain. The goal of intraoperative cortical mapping is to maximize surgical resection in the eloquent area while minimizing the incidence of permanent disabilities. This chapter is intended to provide you with the concepts, indications, and anesthetic considerations important to intraoperative cortical mapping and to prepare you for further reading of more advanced texts and primary literature on this topic.

These two nerves lie in close proximity to one another and are frequently blocked together with the same needle insertion. Dr. Harvey Cushing reported in the Annals of Surgery in 1900 that “almost all cases of hernia, with the possible exception of those in young children, could undoubtedly be subjected to the radical operation under local anesthesia” [1]. Today, because of infrequent use, some authors claim that the block is underutilized for herniorrhaphy [2]. Recently, Yilmazlar and colleagues compared the ilioinguinal/iliohypogastric nerve blocks to spinal anesthesia for inguinal herniorrhaphy. They found that patients receiving the ilioinguinal/iliohypogastric nerve blocks had shorter time-to-home readiness, quicker oral intake postsurgery, and no need for recovery room care [3].

Opiates have been used for pain control for several thousands of years, dating back to the times of the ancient Sumerians. The Sumerians documented poppy in their pharmacopoeia and called it “HU GIL,” the plant of joy (Benedetti 1987). In the third century bc, Theophrastus has the first documented reference to poppy juice (Macht 1915). The word opium is derived from the Greek name for juice obtained from the poppy, Papaver, and the Latin name for sleep inducing, somniferum. Arab traders brought opium to the Orient, where it was used to treat the symptoms of dysentery. Opium contains approximately 20 distinct naturally occurring alkaloids, called opiates, such as morphine or codeine. In 1805, a German pharmacist Sertuner isolated a pure substance in opium and called it morphine. Morphine is named after Morpheus, the Greek god of dreams. After this initial discovery, many more opium alkaloids were discovered. Robiquet isolated codeine in 1832, and Merck isolated papaverine in 1848. In 1898, Bayer Pharmaceuticals launched an alternative to opium and morphine, diacetylmorphine or heroin, from the German word for hero. By the middle of the nineteenth century, pure opium alkaloids, rather than basic opium preparations, spread throughout the medical community. Until the early twentieth century, opioid abuse in the United States increased because of unrestricted availability of opium along with a massive influx of opium-smoking immigrants from the Orient. In fact, Thomas Jefferson grew opium poppies at Monticello. In 1942, the Opium Poppy Control Act banned opium production in the United States (Booth 1999). It is important to differentiate “opioids,” which are substances that act on the opiate receptor, and the term “narcotic,” which is a substance that produces narcosis and can be abused, such as cocaine, cannabis, and barbiturates (Reisine 1996). Narcotics are derived from the Greek word for stupor. Narcotics were initially used for sleeping aid medications rather than for opiates. Narcotic is now a legal term for drugs that are abused. In 2007, 93% of the opiates on the world market originated in Afghanistan (United Nations Office on Drugs and Crime 2007). This amounts to an annual export value of about $64 billion.

Vascular trauma in the military has special importance as combat-related injuries to major vessels offer unique surgical challenges and comprise the majority of potentially preventable deaths on the modern battlefield. The front lines of a battleground are predictably dirty, noisy, and located in predominantly harsh climates. You will routinely perform surgery in tents or abandoned buildings that lack suitable light and ventilation. These austere conditions demand early deliberate preparation to ensure successful management of vascular wounds. Lessons learned during US military operations continue to advance the practice of vascular trauma surgery and now translate into the current recommended surgical practices. Despite the fact that Vascular Surgery has become largely separated from General Surgery, all military surgeons must be well versed in basic vascular anatomy and reconstruction techniques. The majority of combat vascular injuries are not being handled by Vascular Surgeons, and you are unlikely to have one available to guide or assist you. Be prepared, you can be the difference between limb salvage or loss.